Urinary tract infections (UTIs) remain the most common bacterial infection worldwide,
affecting over 150 million people each year. The growing threat of antimicrobial resistance
(AMR) intensifies their impact, contributing to an estimated 4.95 million deaths annually,
with 1.27 million directly linked to AMR. This highlights a crucial need for rapid and
accurate UTI diagnosis to guide timely and appropriate treatment. Conventional microscopy,
culture, and sensitivity (MC&S) testing and dipsticks tends to be unreliable and time
consuming. This study evaluates the 35-minute rapid uropathogen identifier Lodestar Dx as
an alternative to traditional MC&S and urine dipstick for detecting clinically relevant levels
of the six most common uropathogens causing UTIs.

53 samples were collected from patients (mean age 53.4; 38 female and 15 male). 30 patients
were tested due to acute urinary symptoms, 20 due to pre-procedure screening, and 3 were to
ensure uropathogen eradication post-treatment. These samples were tested using the Lodestar
Dx system and the results were compared against the simultaneous gold standard: standard
urine MC&S, and dipstick urinalysis. Impact on the patient pathway was assessed through
analysis of clinical notes, specifically looking at how the instant Lodestar Dx results affected
immediate treatment decisions.

Urine analysis with Lodestar, dipstick and MC&S was performed on 53 samples; two reports
were excluded due to sample errors. The average turnaround time for MC&S was 3 days,
with results actioned after 5 days. Lodestar identified 19 positive results, of which 68.4% (13) were missed by MC&S. 
Only 3 uropathogens (Raoultella ornithinolytica, Citrobacter, and a mixed growth) were picked up solely on MC&S from 32 negative rapid tests, giving a 91% concordance between Lodestar Dx and MC&S. 
The Lodestar Dx found positive growth in 12 of the 36 dipstick-negative samples, including commonly missed non-nitrate concerting
organisms: Enterococcus (n=5), Proteus (n=5), and Pseudomonas (n=2). 
The immediate result from the rapid test led to a 75% change in clinical treatment for patients, either by enabling the immediate prescription of appropriate antibiotics or by excluding a UTI to facilitate early treatment for conditions such as interstitial cystitis/bladder pain syndrome.

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The Lodestar Dx demonstrated strong performance as a rapid and reliable alternative to
standard MC&S and dipstick testing. It efficiently detected numerous infections missed by
both MC&S and dipstick. With a 35-minute turnaround time compared to several days for
culture, Lodestar Dx enabled earlier, targeted treatment decisions and reduced unnecessary
antibiotic exposure, resulting in meaningful improvements in management. These findings
highlight its potential to enhance diagnostic accuracy, improve patient outcomes, and
strengthen antimicrobial stewardship in outpatient urology.